Early Menarche: Is it a Risk Factor
for Depression, Substance Abuse,
and Eating Disorders?
Facilitator: Ann Hung, Mental Health Board Intern
June 8th, 2011
1. Early puberty
2. Biological, environmental, and nutritional
3. Stress hypotheses
4. Negative psychosocial outcomes:
 Substance Use
 Eating Pathology
5. Limitations of research and implications for
clinical practice
Are girls developing
earlier than before?
(Herman-Giddens et al., 1997;
Walvoord, 2010)
Pubarche, thelarche &
Ethnic differences in
onset of puberty
(Obeidallah et al., 2000;
Chumlea et al., 2003)
Biological and Environmental
genes (Brooks-Gunn & Warren, 1988)
father absence (Surbey, 1990; Deardorff et al., 2011)
family conflict
Nutrition and Obesity (Kaplowitz et al., 2001; Davidson et al., 2003)
Stress Hypotheses
(Caspi & Moffitt, 1991)
1. Stressful Change
2. Off-time
3. Early-Timing
Total Behavior Problem Score (RBPC)
Caspi & Moffitt, 1991
Behavior Problems as a function of age at menarche
Theoretical Underpinnings
physical changes
hormonal changes
Comorbidity with other disorders (Patton et al., 1996;
Hayward et al., 1996; Graber et al., 2004)
Results among racial minorities
(Hayward et al., 1999)
(Ge et al., 2003)
Eating Pathology
Two central mechanisms (Stice & Shaw, 2002)
negative affect
Mixed findings re. early menarche on eating pathology
Other factors leading to eating disorders
Precursors and Consequences of Body
Substance Use
Early maturers → increased risk of substance
use (Dick et al., 2000)
Association of girls with older peers (Magnusson et al.,
1986; Moffitt et al., 2001)
Means for self-medication
Racial Differences
cigarette use (Negriff et al., 2010)
Limitations of Current Literature
Lack of follow-up reports
Retrospective data
Measurement criterion
Dearth of racially diverse samples
Implications for Clinical Practice
Spending more time on body dissatisfaction
sociocultural ideals of thinness
critical consumers of mass media
Intervention programs targeted during the most
developmentally challenging and stress
inducing times
Informational programs for parents
5th vital sign
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Girls Who Aggress & Early Menarche